Yüksel Alper, Ugur Kadriye Serife, Kizilbulut Gultekin, Ark Nebil, Kurtaran Hanifi, Kaya Mesut, Gunduz Mehmet
Department of Otorhinolaryngology, Head and Neck Surgery, Turgut Ozal University Faculty of Medicine, Ankara, Turkey.
Turgut Ozal University Hospital, Alpaslan Turkes Caddesi No:57, Emek, 06510, Ankara, Turkey.
Eur Arch Otorhinolaryngol. 2016 May;273(5):1227-34. doi: 10.1007/s00405-015-3813-4. Epub 2016 Jan 29.
The objective of this study is to evaluate and compare the long-term efficacy of the one staged multilevel surgery (MLS) with tongue suspension (TBS) surgery or one level palatal surgery for treatment of moderate and severe obstructive sleep apnea (OSA). This is a prospective cross-sectional study.
University hospital. Thirty-three patients diagnosed as moderate to severe OSA. Patients, with ≥ 50 % retropalopharyngeal obstruction on the Müller maneuver, were treated with palatal surgeries (PS) and patients, with ≥ 50 % retropalopharyngeal obstruction on the Müller maneuver with ≥ 50 % base of the tongue collapse, were treated with palatal surgeries and tongue suspension surgery (TBS). Patients were evaluated with one night polysomnography before the surgery and 24 months after the surgery. Patients completed Epworth sleepiness scale (ESS), snoring VAS (visual analog scale) before and 24 months after the surgery. Nine-teen patients with a mean age of 46.1 ± 8.3 underwent palatal surgeries (PS) and 14 patients with a mean age of 41.4 ± 8.9 underwent PS plus TBS. Success rate in TBS+PS group was 57.1 % and in PS group was 42.1 %. In both groups total apnea-hypopnea index (AHI) values significantly decreased after 2 years (p < 0.025) but there was no statistically significant difference between TBS+PS and PS groups. Supine AHI levels were reduced statistically significant in both groups postoperatively (p < 0.025). There was not any significant difference postoperatively in non-supine AHI levels in both groups (p > 0.025). There were significant postoperative changes in ODI, AVO2, MOS, ESS, Snoring VAS values in PS group (p < 0.025). In TBS+PS group there was a significant difference postoperatively only in ODI values. Treatment of OSA patients with retropalatal or retropalatal and retroglossal obstruction, in a one staged surgery, is a safe and easy procedure. We have achieved favorable long-term outcomes in moderate-severe OSA patients undergoing both palatal surgery and tongue suspension surgery.
本研究的目的是评估并比较一期多级手术（MLS）联合悬舌术（TBS）或单级腭部手术治疗中重度阻塞性睡眠呼吸暂停（OSA）的长期疗效。这是一项前瞻性横断面研究。
大学医院。33例被诊断为中重度OSA的患者。在米勒检查中腭后咽阻塞≥50%的患者接受腭部手术（PS），在米勒检查中腭后咽阻塞≥50%且舌根塌陷≥50%的患者接受腭部手术和悬舌术（TBS）。患者在手术前和手术后24个月接受一晚的多导睡眠图评估。患者在手术前和手术后24个月完成爱泼沃斯嗜睡量表（ESS）、打鼾视觉模拟量表（VAS）。19例平均年龄为46.1±8.3岁的患者接受了腭部手术（PS），14例平均年龄为41.4±8.9岁的患者接受了PS加TBS。TBS+PS组的成功率为57.1%，PS组为42.1%。两组的总呼吸暂停低通气指数（AHI）值在2年后均显著下降（p<0.025），但TBS+PS组和PS组之间无统计学显著差异。两组术后仰卧位AHI水平均有统计学显著降低（p<0.025）。两组非仰卧位AHI水平术后无显著差异（p>0.025）。PS组术后ODI、AVO2、MOS、ESS、打鼾VAS值有显著变化（p<0.025）。TBS+PS组术后仅ODI值有显著差异。在一期手术中治疗腭后或腭后及舌后阻塞的OSA患者是一种安全简便的手术。我们在接受腭部手术和悬舌术的中重度OSA患者中取得了良好的长期疗效。
